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  • Catatan Kesehatan Ibu Bersalin Ibu Nifas Dan Bavi Baru Lahir

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    This document contains forms for recording referrals, diagnoses, and treatments for postpartum mothers and newborns. The forms include sections for documenting referral details, including date, reason for referral, preliminary diagnosis and treatments. A feedback section records the diagnosis, treatments and recommendations from the receiving medical provider. Multiple referral forms are included to track any additional referrals as needed.

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    This document contains forms for recording referrals, diagnoses, and treatments for postpartum mothers and newborns. The forms include sections for documenting referral details, including date, reason for referral, preliminary diagnosis and treatments. A feedback section records the diagnosis, treatments and recommendations from the receiving medical provider. Multiple referral forms are included to track any additional referrals as needed.

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    © All Rights Reserved
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    5 views2 pages

    Catatan Kesehatan Ibu Bersalin Ibu Nifas Dan Bavi Baru Lahir

    Uploaded by

    EndangSaputra
    This document contains forms for recording referrals, diagnoses, and treatments for postpartum mothers and newborns. The forms include sections for documenting referral details, including date, reason for referral, preliminary diagnosis and treatments. A feedback section records the diagnosis, treatments and recommendations from the receiving medical provider. Multiple referral forms are included to track any additional referrals as needed.

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    © All Rights Reserved
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    of 2

    ·rif:1?~~- _ .,..

    CATATAN KESEHATAN IBU BERSALIN


    itf '!
    · I l l_ .
    -- IBU NIFAS DAN BAVI BARU LAHIR

    RUJUKAN
    Tanggal/bulan/tahun : •·· ··· ·· I ............. ... . I ... ......... Jam : ............ .......... .
    Dirujuk ke ............................................................ .... .. .. ..........
    Sebab dirujuk ............................................... .. .. ..........................
    Diagnosis sementara : .......................................................................... . ..
    Tindakan sementara : ·································································· ···········
    ·············································································
    Yang merujuk

    .................................................

    UMPAN BALIK RUJUKAN


    Diagnosis .................................... ..........................................
    Tindakan ··············································································
    Anj uran
    Tanggal
    Penerima Ruj ukan

    RUJUKAN
    Tanggal/bulan/tahun : ........ / .... ............. / ............ Jam : ........................ .
    Diruj uk ke
    Sebab diruj uk
    Diagnosis sementara :
    Tindakan sementara :
    ·········································································· ·· ··
    Yang meruj uk

    ·················································

    UMPAN BALIK RUJUKAN


    Diagnosis .............................................................................
    Tindakan ..................................................... ..... ...................
    Anjuran .............................................................................
    Tanggal
    ···········································p~~~~i~~·R~j~k~~······

    ··············································

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